What is a medical home? Will it cut health-care costs? Definition and doctors’ opinions.

by James Hubbard, M.D., M.P.H.

I’m jumping the gun a bit, but I thought you should have a heads up in case President Obama mentions the new buzz phrase “medical home” in his State of the Union Address.

Since his election, President Obama hasn’t said much about universal health care, although I’m sure that’s his long-term goal.  He’s mostly talked about cutting costs, with a definition only politicians can get away with: Lower costs means slowing said costs’ growth. Instead growing 10 percent per year, maybe we can slow to 6 or 4 percent.

Of course any improvement, without diminishing quality, will be welcome.  Obama’s plan so far is to update health-care technology, such as implementing electronic medical records and (I hope he means) streamlining red tape.  Time will tell how much that will really save.


DOCTOR ORGANIZATIONS’ IDEA FOR HEALTH-CARE REFORM

Not to be left out of the health-care reform debate, professional medical organizations are pushing their own agenda. The concept of a medical home is big among primary-care groups like the American Academy of Family Physicians, American Academy of Pediatrics and American College of Physicians (internal medicine doctors).  The American Medical Association also thinks it’s a good idea.


WHAT IS A PATIENT CENTER OR PERSONAL MEDICAL HOME?

Best I can tell, it means every person should have a primary-care doctor in charge of coordinating care. The current health-care system is fragmented.  Your bevy of specialists don’t always communicate well with each other.  Your treatment can become duplicated or medications mixed wrongly, or a specialist may be treating things your primary-care doctor could do cheaper and more efficiently.  At least, that’s the premise.

So I’m thinking, this isn’t a new concept. It has been around as long as I have.  It’s really what primary care is all about, just put in buzzword terms.


WHAT’S DIFFERENT ABOUT A MEDICAL HOME?

Medical-home proponents disagree. First, they say we’re not talking about the gatekeeping concept as seen in HMOs. You can still see the doctor of your choice when you want, but, don’t you know, everyone needs a home–a cozy place where everybody knows your name.  More to the point, the medical home should be a place where you can have your preventive and primary-care needs taken care of, be referred for tests or specialist treatment when appropriate and have all your records kept in one place.

Well, how is that different from now? For one thing, proponents hope your primary-care physician will reimbursed for the extra time and office resources spent on making coordination a priority.  Currently, insurances don’t place a lot of monetary value on time or administrative costs unless a procedure is involved.  Getting paid would help prove these time-consuming tasks do have value and might even entice physicians to go into primary care–because another problem is we already have a shortage in that field.


HOW CAN WE AFFORD A MEDICAL HOME?

OK, where is this new money coming from? Ah, there’s the rub.  Of course, medical-home proponents say care will be more efficient, people healthier, etc.  Critics counter that preventive checkups and exams for all will not save money and, in fact, may increase costs overall. (More tests mean more positive findings and more procedures and treatments).


FIGHT!

A primary-care doctor wrote in the The Wall Street Journal that we could afford it if we cut specialist reimbursements, along with lab and X-ray. As you might guess, specialists are not so keen on this share-the-wealth, kumbaya idea.  In fact an emergency-room specialist recently wrote his opinion in major ER journal that, in essence, primary care should be abandoned, abolished, let die.  He thought the care the primary care doctors gave was inferior and had examples to prove his point.  It was nasty.

Let the turf wars begin.

Doctors and business owners: Send customized issues of James Hubbard’s My Family Doctor to your customers or patients. E-mail publisher-at-familydoctormag.com for details.

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6 Responses to “What is a medical home? Will it cut health-care costs? Definition and doctors’ opinions.”

  1. cathy Says:

    Wow. I am blissfully ignorant of most of the ideas to fix our medical system. Not sure what I think of this, but it really doesn’t sound like establishing Medical Homes is THE answer. Thanks for providing an overview!

    cathys last blog post..Being a good guest when eating healthier

  2. James Hubbard, M.D., M.P.H. Says:

    Cathy, I have read Obama is for them as part of his evolving plan. I think it is anyone’s guess what the final product will be.

  3. Tim Says:

    I have a really great idea. Quit going to the doctor all together, as I have, and become healthier and have more money.

  4. James Hubbard, M.D., M.P.H. Says:

    Tim,

    Glad you are healthier, and not a bad idea, to an extent.

  5. Brandon Betancourt Says:

    I run a private pediatric practice (just pediatrics, no specialty) so I’m sure others are going to say that my answer is biased; and maybe it is.

    The Medical Home concept doesn’t seem to address some of the biggest problems with primary care which include lower reimbursements for providers despite increases in cost to provide the same services and access to care among many other things. By its current definition, the Medical Home is not any different than what primary care doctors (PCP) do today. Granted, improvements can be made to increase communication and share information better among physicians, hospitals and other providers, but fundamentally PCP’s are already providing a medical home.

    It seems to me there are a lot of great arguments that will enhance the healthcare system. The problem is, the healthcare system is broken. Before we can improve it, we need to fix what is wrong with it. It is like putting new tires on a car with a broken motor. You can enhance the car’s appearance all you want, but if you don’t fix the motor, you are not going anywhere.

    I suggest start asking why?

    Why are the number of primary care doctors in decline?
    Why is it so difficult to get reimbursement from insurance company?
    Why do medical providers have to wait on average of 45 days before they get paid for services rendered?
    Why do vaccines cost rise, but reimbursement stays the same?
    Why do providers write off thousands (and in some cases millions) of dollars in bad debt?
    Why does Medicare decrease GPCI (factor used in pricing medical services)?
    Why do insurance companies decide what is appropriate reimbursement for services provided?
    Why is it we live in the richest country in the world and we have a mediocre healthcare system?
    Why does one have to wait hours to be seen in an Emergency Room?
    Why do people go to the ER instead of their PCP?

    Keep on asking why until there are no more why’s to ask… That is where we need to start.

  6. James Hubbard, M.D., M.P.H. Says:

    You ask great questions. I think a lot of us in primary care would ask the same. Just from past experience, I expect we will be asked to carry a larger load, more responsibility with not enough extra reimbursement to even meet the increase in administrative costs.

    Some decision makers need to ask, is primary care important. If it is, then answer your questions. If not,expect it to fade out.

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